FORT BEND COUNTY SHERIFF’S OFFICE CITIZEN

COMPLAINT INFORMATION

Emergency Notices

Name

D.O.B

DRIVER’S LICENSE NUMBER/ID CARD

Address

Home Phone

Work Phone

OTHER PHONE (CELL,etc..)

Employee Names

Date Of Incident

Time Of Incident

Location of Incident

Details of Incident

NOTICE TO COMPLAINANT

This is a Governmental Record

Pursuant to Section 37.10 of the Texas Penal Code

It is unlawful to make a false entry on a governmental record.

Complainant’s Printed Name

Complainant’s Signature

Date

Person Receiving Complaint Printed Name*

# of pages

Person Receiving Complaint Printed Name*

# of pages

Signature of Person Receiving Complaint (Type your name as signature)

Date

*This is the FBCSO employee who initially receives written and signed complaint from complainant **Enter total # of pages submitted for this complaint